Episode of throat infection defined as sore throat AND 1 or more of the following:
Fever >38.3°C
Cervical adenopathy (tender lymph nodes or >2 cm)
Tonsillar exudate
Positive test for group A beta-hemolytic streptococcus
Watchful waiting for recurrent throat infection recommended if:
<7 episodes in the past 1 year, OR
<5 episodes/year in the past 2 years, OR
<3 episodes/year in the past 3 years
Consider tonsillectomy for:
Recurrent throat infection with a frequency of:
≥7 episodes in the past year, OR
≥5 episodes/year for 2 years, OR
≥3 episodes/year for 3 years
Special cases:
Recurrent throat infection with multiple antibiotic allergy/intolerance
Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome - occurs primarily <5 years old, episodes usually <5 days, recur at regular intervals of 3-6 weeks, and includes acute fever, pharyngitis plus tender cervical LAD, or aphthous ulcers.
Steroids cause prompt termination of an episode, the interval between episodes shortens. Cimetidine may be helpful. Tonsillectomy effective.
History of peritonsillar abscess
Sleep disordered breathing (SDB)
Diagnosis of SDB in children may be based on history, physical examination, audio/video taping, pulse oximetry, or limited or full-night polysomnography (gold standard)
Tonsillar and adenoid hypertrophy (usually 3-4+) is recognized as the most common cause of SDB in children
Obesity plays a key role in some
History of snoring neither includes nor excludes SDB, as not all children who snore have SDB
SDB may contribute to growth retardation, poor school performance, enuresis, and behavioral problems, and these problems may improve with tonsillectomy
Tonsillectomy more effective for SDB in normal weight children (60-70%) vs obese children (10-25%)
Physical Exam
Table of Contents
ENT Clinical Practice Guideline (2011)
References